Wednesday, February 19, 2014

The Medical Model vs. The Nursing Model

The Medical Model vs. The Nursing Model

It was none other than Florence Nightingale (1859) who thought medicine
and nursing should be differentiated from one another. Even in the
1970's, physicians were still lecturing nurses about nursing.
Strikingly, BSAVA Congress reported veterinary surgeons lecturing nurses
about nursing in 2005! In 1985, Stockwell defined a "model" as a "simplified way of organising a complex phenomenon." The medical and nursing models are some of the most widely talked about topics in PA, NP, and medical interviews. However, it is up to the student to do much of the research about these topics and truly understand their profession and the basis behind the practice they are about to commence. Although difficult to understand and convoluted, the medical and nursing models are strikingly unalike in the most basic ways. I hope this article brings light to just that for you and that you may begin to see the true differences.

The Medical Model (PA and MD/DO)

Medical and PA schools both follow a disease-model that appears to
be well illustrated with more pathology, clinical medicine, pharmacology,
pathophysiology, differential, treatment, etc. Specifically, it emphasizes anatomical, physiological and biochemical malfunction as the causes of ill health and by doing so encourages a disease -oriented approach to the patient. The medical model treats the human body as a "complex set of anatomical parts and physiological systems," if you will (Aggleton & Chalmers, 2000). The content of many PA programs also focuses on caring for patients across
their entire life span and is designed to prepare PAs for practice in
multiple care settings - primary care, emergency/acute care, the
operating room, inpatient and outpatient settings.

The medical model is believed to be derived out of diagnosis of a psychiatric patient with a mental illness who was given a clinical diagnosis based on behavior, rather than physical pathology. The medical model followed a workflow of diagnosis and then diagnostic examination and ancillary testing. Stipulations on the derivations of the medical model are ongoing.

The medical model does not account for much of lifestyle-teaching or cultural considerations like the nursing model. Instead, it is an
evidence-based approach to the treatment of diagnoses, based upon the
gathering of a history and physical alone.

The Nursing Model (NP)

The nursing model focuses on patient’s mental, emotional, and physical needs
and could be expressed as immediate care leading into long term
effects. "It is a mental or diagrammatic representation of care, which is systematically constructed, and which assists practitioners in organising their thinking about what they do, and in the transfer of their thinking into practice for the benefit of the patient and the profession (McKenna, 1994)". Essentially, the nursing model accounts for the whole patient,
not just the disease or condition requiring treatment. It allows nurses to deliver care to patients using a systematic approach of assessing, planning, implementing and evaluating patient care - this is a cyclic nursing process with detailed guidance for each step of care.

Nurses believed that the medical model was not a focus of their
discipline, but with the advent of university educated nurses and the
quest for professional recognition, the nursing model evolved. Nursing
is sometimes called "holistic practice" or "integrative medicine"
and this could be because NPs often take courses in therapeutic
communication.This type of medicine focuses on health and wellness of the overall
patient rather than treating the disease itself and focusing on the
patient-physician relationship. NP programs are grounded in the nursing model and help students master
competencies required for the care of multiple populations (adults,
children, and families).

Nurses (RNs) come from a background of
“care plans” where they associate nursing assessments for their patients,
but not medical diagnoses. Detailed assessments are necessary to establish the individuality of the patient. Planning is done to prevent recurrence of treated problems. Goals are set so that evaluation can be measured or tested. Plans are made for intervention to achieve goals. Evaluation is done to analyze whether improvement was made. Once complete, effective care is believed to be given. However, this is a nursing process, incomplete without a scientific foundation or a systematic construction.

The nursing model itself has a different structure. Roper, Logan, and Tierney (2000) describe the five parts of the nursing model as:

Ex. NP must be aware of psychological stressors on Activities of Living and impacts on patient. Patient suffering from anxiety may withdraw from communication, refuse to eat and drink and be unable to sleep.

Individuality in Living (Each patient may do them differently, expressing themselves as an individual)

A PA, physician, and NP work side by side
and do the same things in the same ways. Most can perform line
removals, manage medications, perform H&Ps, etc. Although there are differences, there is also lots of
crossover in both models. It is crucial that you realize there are good and bad physicians, PAs and NPs all around
and it is important to recognize that we cannot pinpoint one poor
practitioner’s mistakes on an entire group of providers. Even though we may be trained in different models, come from various backgrounds, have unequal amounts of experience, etc. we are all responsible for the same patients and the same goals. We work as a team to ensure patient safety and life longevity.

11 comments:

Well, when it comes to medical model vs nursing model, often it' crucial to realize there are good and bad physicians, PAs and NPs all around and it's important to recognize that one cannot pinpoint one poor practitioner’s mistakes on an entire group of providers.

This is great! Thanks for differentiating the roles of practitioners by their learning models. It helps tremendously especially when so many of the responsibilities/roles overlap as you said among NPs/PAs/MDs/DOs at the primary care level. Really appreciate it especially for someone that is trying to decide which career path to take!

TY so much for taking the time to research and share these insights. I'd like to add one piece of info and point out what I believe to be a contradiction. The nursing process is first well outlined as a systematic approach to a persons whole health needs and then you state that it is unsystematic and not founded on science, meaning it is not "evidence-based". Please refer to the Nursing Science Quarterly which is a publication that has been around for many years and dedicated solely to nursing research and science. Nursing is a unique science, that has earned its place among the professions. We have a body of knowledge that advances our practice that is informed by but different from medicine. Because we deal with the human experience our research is often more qualitative. Nursing is interested in how patient's experience things with the aim of providing help that is valued by the individual. . The research is harder because understanding what is important to people is complex, but it is indeed important and a scientific approach is the only way to go in my book. Research costs money. I am optimistic that nursing professionals will continue to amaze and benefit people, worldwide. TY for starting a dialogue.

Hello Paul, first thanks for this post. From the post, it would seem that since physicians and PAs both abide by the medical model, their day to day practice would be very similar. I've been under the impression (whether it's incorrect or not) that the PA profession is mainly clinically focused, not involving as much consideration of the pathophysiology behind procedures and treatment, as it's the duty of the MDs to focus on that. Is this the case? I enjoy studying the physiology and biochemistry of the human body, and was worried that PA practice wouldn't deal much if at all with those things. But I've also heard that since MDs and PAs are both clinicians, neither deal with those things on a day to day basis anyway. I'd appreciate your thoughts, thank you.

Had I known that studying for my BSN to become a Registered Nurse would entail following one of many "Nursing Theories/Models", I would have become a PA instead. Care plans were a waste of time as the actual practice of nursing entails a thorough knowledge of pathophysiology, clinical diagnoses,and in essence, the DISEASE-ORIENTED approach (i.e., the Medical Model) to interve with a client/patient. Nursing theories/models I believe, should be disavowed as care, technology & treatment is ever increasingly becoming more sophisticated. Of course one must consider the "person inside the body", but the lab tests, assessments, diagnoses & treatment options need to be the emphasis to nursing rather than wasting time studying things like different charting methods. In my BSN program, I only actually injected two patients, never started an IV, and got overwhelmed with useless management, outcome evaluation and endless unnecessary paperwork. Care plans in school taught me NOTHING! I purchased many books & took courses outside-nursing-curriculum on my own such as legal aspects of medical professionals. Nursing schools should go away entirely and be replaced by Physicians' Assistant programs. What I learned in nursing schools is that the practice of actual nursing is not at ALL like what is taught in nursing school. I eventually left the field and went back to doing biostatistics & research methodology from my Ph.D. studies I had completed prior to attending an accelerated BSN program. The ONLY benefit to being a BSN educated RN is that, now that I'm older, I am educated enough to call the shots in my own care, be my own advocate and assist MDs tremendously by providing them with a 1-page categorization of my Hx, surgeries, allergies, treatments, current meds & deleterious side effects of previous interventions. All my MDs & PAs are most impressed & I don't have to listen to simple non-professional terminology when I see my specialists. As an employee in several large hospitals, I experienced gossip, harassment, back-stabbing & all negative & unprofessional stereotypical 'female behavior'. I'm glad I have the knowledge: I'm thrilled not to have to practice what I once believed to be an admirable career. It's just dirty work & typing.

I wholeheartedly agree with the response above (6/8/17). I'm a BSN prepared RN, currently working on an MSN. In my specialty area, I work independently in a non-healthcare agency as "nursing services." I provide services as a health advocate for children with special needs, creating health plans for an environment staffed by laymen. There are scheduled treatments/procedures and PRN plans for emergencies. I am frequently called upon to communicate with medical specialists, then translate these communications into common language for education team use. I assist parents in finding resources to meet the needs of unique health conditions. Nursing care plans from my early years helped form the process I use to help create customized safe, healthy learning environments for these students. This is just a small (but important) part of my entire job description. It's not just "dirty work and typing." I'm sorry the original poster had an experience like that but his/her experience is not the same for every RN, I can guarantee.

I hope you get a chance to respond to my questions. I have recently completed almost all (53 cr hrs) of my PA premed prereq's with a 3.7 GPA but I have a dual major undergrad degree-BS Biology/Native American studies, Earth Science minor from 20 years ago where my GPA was only a 2.5. Statistically and financially, I cannot raise my cummulative GPA up to the required 3.2 for PA school. Also I am 49 years old and already owe 50K in student loans. I just graduated with an AS Applied Health Science-minor Chemistry to make use of my premed courseworK and have been accepted into the last two years of a BSN program. I have never wanted to be a nurse. I spent 8 years in the hospitals with my terminally ill child and I saw the role that nurses have. They do not posses the kind of upper division Lifescience courses that I love and are were not able to answer my questions on my sons pathophysiology, nor did they listen to me when I would instruct them on how best to administer drugs or medications to my child. I was always intrigued and impressed by the MD's knowledgebase and skills on the other hand. My question for you is - How do I know if Im CAPABLE of completing a RIGOROUS PA program. I cant afford to make a mistake and end up dropping out. For the past five years Ive slowly accumulated the PA prereqs but I was not taking 15 cr/semester. Only one class and lab at a time. The PA curriculum and 23 cr hrs per semester scares the hell out of me. My classmates are 25 years younger than me and have been raised using a computer. Again Im a non trad but professional life long student. Im of average intelligence, not super smart or proficient on the computer either but much better than I was 20 years ago when I graduated. Please help with any advice you can. I dont want to have to become a BSN nurse. I do not like working with people who gossip. I do not like making care plans and outcomes, etc. I love hard core biological and medicinal science I just wished there was a PA program that would allow me more time to complete. WHY THE RUSH TO CRAM 90 CR HRS INTO 26 MONTHS UNDER EXTREME RIGORUOSNESS, STRESS, AND FINACIAL BURDEN OBLIGATION-90K IN STUDENT LOANS?

My experience with a BSN school of nursing was disappointing. The school blatantly cut down MDs and focused on nurses as researchers, leaders, management, and insisted nursing was an equal in skill and value to medicine. Of course nursing has value, but nurses do not have the skill or knowledge of MDs. If you want to practice medicine go to medical school. I could have graduated with a ton of practical skill, but instead I was indoctrinated with nonsense and did not get the practical skills I needed. I would not recommend a BSN program. Nor a doctor of nursing. Go to medical school if you want to practice medicine.